Publications by authors named "Alisa Femia"

57 Publications

Chronic Hydroxychloroquine Therapy and COVID-19 Outcomes: A Retrospective Case-Control Analysis.

J Am Acad Dermatol 2021 Jan 10. Epub 2021 Jan 10.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.10.098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797175PMC
January 2021

Acrofacial purpura and necrotic ulcerations in COVID-19: a case series from New York City.

Int J Dermatol 2020 Nov 23;59(11):1419-1422. Epub 2020 Sep 23.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.

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http://dx.doi.org/10.1111/ijd.15181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537226PMC
November 2020

Clinical Characteristics of Lupus Erythematosus Panniculitis/Profundus: A Retrospective Review of 61 Patients.

JAMA Dermatol 2020 Sep 2. Epub 2020 Sep 2.

The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York.

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http://dx.doi.org/10.1001/jamadermatol.2020.2797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489404PMC
September 2020

Response to "Patient preference for cellulitis treatment: at-home care is preferred to hospital-based treatment".

J Am Acad Dermatol 2020 Aug 7. Epub 2020 Aug 7.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY.

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http://dx.doi.org/10.1016/j.jaad.2020.07.120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413198PMC
August 2020

An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19.

Lancet 2020 07 10;396(10246):e8-e10. Epub 2020 Jul 10.

Ronald O Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY 10016, USA. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(20)31526-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351414PMC
July 2020

Dermatologists' Role in the Diagnosis and Management of Coronavirus Disease 2019 Coagulopathy.

Am J Clin Dermatol 2020 08;21(4):599-600

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 E 38th St 14th floor, New York, NY, 10016, USA.

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http://dx.doi.org/10.1007/s40257-020-00540-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343906PMC
August 2020

Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.

J Am Acad Dermatol 2020 May 7. Epub 2020 May 7.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, United States. Electronic address:

Background: Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data.

Methods: This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic.

Results: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median kappa = 0.83), substantial agreement in laboratory work-up decisions (median kappa = 0.67), almost perfect agreement in imaging decisions (median kappa = 1.0), and moderate agreement in biopsy decisions (median kappa = 0.43). There was almost perfect agreement in treatment (median kappa = 1.0), but no agreement in follow-up planning (median kappa = 0.0). There was no association between raw photo quality and the primary plus differential diagnosis or primary diagnosis alone.

Limitations: Selection bias and single-center nature.

Conclusions: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
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http://dx.doi.org/10.1016/j.jaad.2020.04.171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204758PMC
May 2020

Evaluation of the Effectiveness and Tolerability of Mycophenolate Mofetil and Mycophenolic Acid for the Treatment of Morphea.

JAMA Dermatol 2020 05;156(5):521-528

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.

Importance: First-line systemic therapy for morphea includes methotrexate with or without systemic corticosteroids. When this regimen is ineffective, not tolerated, or contraindicated, a trial of mycophenolate mofetil (MMF) or mycophenolic acid (MPA)-referred to herein as mycophenolate-is recommended; however, evidence to support this recommendation remains weak.

Objective: To evaluate the effectiveness and tolerability of mycophenolate for the treatment of morphea.

Design, Setting, And Participants: A retrospective cohort study was conducted from January 1, 1999, to December 31, 2018, among 77 patients with morphea from 8 institutions who were treated with mycophenolate.

Main Outcomes And Measures: The primary outcome was morphea disease activity, severity, and response at 0, 3 to 6, and 9 to 12 months of mycophenolate treatment. A secondary outcome was whether mycophenolate was a well-tolerated treatment of morphea.

Results: There were 61 female patients (79%) and 16 male patients (21%) in the study, with a median age at disease onset of 36 years (interquartile range, 16-53 years) and median diagnostic delay of 8 months (interquartile range, 4-14 months). Generalized morphea (37 [48%]), pansclerotic morphea (12 [16%]), and linear morphea of the trunk and/or extremities (9 [12%]) were the most common subtypes of morphea identified. Forty-one patients (53%) had an associated functional impairment, and 49 patients (64%) had severe disease. Twelve patients received initial treatment with mycophenolate as monotherapy or combination therapy and 65 patients received mycophenolate after prior treatment was ineffective (50 of 65 [77%]) or poorly tolerated (21 of 65 [32%]). Treatments prior to mycophenolate included methotrexate (48 of 65 [74%]), systemic corticosteroids (42 of 65 [65%]), hydroxychloroquine (20 of 65 [31%]), and/or phototherapy (14 of 65 [22%]). After 3 to 6 months of mycophenolate treatment, 66 of 73 patients had stable (n = 22) or improved (n = 44) disease. After 9 to 12 months of treatment, 47 of 54 patients had stable (n = 14) or improved (n = 33) disease. Twenty-seven patients (35%) achieved disease remission at completion of the study. Treatments received in conjunction with mycophenolate were frequent. Mycophenolate was well tolerated. Gastrointestinal adverse effects were the most common (24 [31%]); cytopenia (3 [4%]) and infection (2 [3%]) occurred less frequently.

Conclusions And Relevance: This study suggests that mycophenolate is a well-tolerated and beneficial treatment of recalcitrant, severe morphea.
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http://dx.doi.org/10.1001/jamadermatol.2020.0035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113833PMC
May 2020

Mycophenolate Mofetil for Eosinophilic Fasciitis: A Retrospective Analysis From 3 Tertiary Care Centers.

JAMA Dermatol 2020 05;156(5):595-597

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamadermatol.2020.0120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113824PMC
May 2020

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults.

J Am Acad Dermatol 2020 Jun 7;82(6):1553-1567. Epub 2020 Mar 7.

Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.
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http://dx.doi.org/10.1016/j.jaad.2020.02.066DOI Listing
June 2020

Dermatomyositis: An Update on Diagnosis and Treatment.

Am J Clin Dermatol 2020 Jun;21(3):339-353

Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.

Dermatomyositis is a rare inflammatory disease with characteristic cutaneous findings and varying amounts of systemic involvement. Patients may present with skin disease alone, have concomitant muscle disease, or have extracutaneous manifestations such as pulmonary disease or an associated malignancy. Given such diverse presentations, dermatomyositis is both a diagnostic and therapeutic challenge. However, a prompt diagnosis is of utmost importance to institute adequate therapy and screen patients for an associated malignancy. Dermatologists should play a crucial role in the diagnosis and management of patients with dermatomyositis as cutaneous disease tends to be chronic, negatively impact quality of life, and be more recalcitrant to therapy. In this review, we discuss diagnosis, with a focus on myositis-specific antibodies and their associated phenotypes. We also review therapies available for this often refractory skin disease.
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http://dx.doi.org/10.1007/s40257-020-00502-6DOI Listing
June 2020

Comparison between organismal staining on histology and tissue culture in the diagnosis of cutaneous infection: A retrospective study.

J Am Acad Dermatol 2020 Jun 28;82(6):1400-1408. Epub 2020 Jan 28.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Background: In instances of suspected cutaneous infection, the standard of care includes obtaining skin biopsy specimens for histology and tissue culture. Few studies have compared the clinical utility of each test.

Objective: To assess the concordance of results between tissue culture and histology, as well as the clinicopathologic features that may influence the diagnostic yield of each test.

Methods: A retrospective review of all patients who underwent skin biopsy for histology and tissue culture at New York University from 2013 through 2018.

Results: Of 179 patients, 10% had positive concordance, 21% had positive tissue culture only, and 7% had positive histology only. We calculated a kappa correlation coefficient of 0.25 between histology and tissue culture (reference, 0.21-0.39 indicates minimal agreement). Histology exhibited higher sensitivity in detecting fungi, whereas tissue culture was more sensitive in identifying Gram-negative bacteria. Antimicrobial use before biopsy led to significantly fewer positive cultures (37.5% vs 71%; P = .023) in patients ultimately diagnosed with infection.

Limitations: This study was conducted at a single institution, thereby restricting its broad applicability. The lack of a validated criterion standard to diagnose infection also limits interpretation of the results.

Conclusion: Tissue culture and histopathology often yield discordant results. Dermatologists should recognize specific limitations, yet high clinical utility in special circumstances, of tests when approaching cases of suspected infection.
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http://dx.doi.org/10.1016/j.jaad.2020.01.047DOI Listing
June 2020

Comment on "Skin disease of the breast and nipple".

J Am Acad Dermatol 2020 Jan 20. Epub 2020 Jan 20.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2020.01.029DOI Listing
January 2020

Clinical Characteristics and Medical Management of Idiopathic Granulomatous Mastitis.

JAMA Dermatol 2020 04;156(4):460-464

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York.

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http://dx.doi.org/10.1001/jamadermatol.2019.4516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990845PMC
April 2020

Intravenous Immunoglobulin for Refractory Eosinophilic Fasciitis: A Retrospective Analysis from 3 Tertiary Care Centers.

J Am Acad Dermatol 2019 Dec 14. Epub 2019 Dec 14.

The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.12.022DOI Listing
December 2019

Willingness-to-pay stated preferences in cutaneous lupus erythematosus: a pilot study.

Arch Dermatol Res 2020 Sep 26;312(7):527-531. Epub 2019 Nov 26.

Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.

Cutaneous lupus erythematosus (CLE) is a chronic skin disease that significantly impacts quality of life (QOL). This study tested a novel method to measure QOL in CLE using willingness-to-pay (WTP) stated preferences, and aimed to determine which of nine domains of life are most affected by CLE. Twenty-one participants with CLE ranked the domains in order of impact on CLE-related QOL, and then stated how many United States dollars they would be willing to pay for a hypothetical cure for each domain. Eighty-one percent of participants were female; mean age was 42.4 years. Photosensitivity was ranked highest by 71.4% of respondents. Participants were willing to pay the most for a hypothetical cure for CLE specific to photosensitivity (median = $200,000), the least for a cure specific to self-care (median = $0). Participants were willing to pay a median of $1,000,000 for an overall cure for CLE. Limitations include a small sample size for this pilot study and that willingness-to-pay may be influenced by individual perception of money and socioeconomic factors. This study successfully pilot-tested a WTP method and ranking task for health-related QOL. Photosensitivity was the domain of life most affected by CLE, which is a domain unique to our novel tool.
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http://dx.doi.org/10.1007/s00403-019-02006-8DOI Listing
September 2020

Systemic sclerosis with malignant acanthosis nigricans in a patient with gastric adenocarcinoma.

JAAD Case Rep 2019 Dec 20;5(12):1045-1047. Epub 2019 Nov 20.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2019.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6872833PMC
December 2019

Clinical epidemiology and treatment of lichen planus: A retrospective review of 2 tertiary care centers.

J Am Acad Dermatol 2019 12 17;81(6):1397-1399. Epub 2019 Apr 17.

Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.04.027DOI Listing
December 2019

Assessment of Antimalarial Therapy in Patients Who Are Hypersensitive to Hydroxychloroquine.

JAMA Dermatol 2019 Apr;155(4):491-493

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1001/jamadermatol.2018.5212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459084PMC
April 2019

Pityriasis rubra pilaris: A study evaluating patient quality of life in 2 populations.

J Am Acad Dermatol 2019 08 30;81(2):638-640. Epub 2019 Jan 30.

Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.01.061DOI Listing
August 2019

Acquired immune deficiency syndrome-related epidemic Kaposi sarcoma.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perleman Department of Dermatology, New York University Langone Health, New York, New York.

Kaposi sarcoma (KS) is a vascular neoplasm that is one of the most common human immunodeficiency virus (HIV)-related malignancies. We present the case of a 42-year-old man with a new diagnosis of HIV and acquired immune deficiency syndrome (AIDS)-related epidemic KS.
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December 2018

Generalized essential telangiectasia.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York.

The pathophysiology of generalized essential telangiectasia is not well understood. Generalized essential telangiectasia is an uncommon disorder in which widespread telangiectasias of unknown cause develop without associated systemic or antecedent dermatologic disease. We report a case of generalized essential telangiectasia in an otherwise healthy 49-year-old man.
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December 2018

Systemic Treatment for Clinically Amyopathic Dermatomyositis at 4 Tertiary Care Centers.

JAMA Dermatol 2019 Apr;155(4):494-496

Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamadermatol.2018.5215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459090PMC
April 2019

Durable response to anti-PD-1 immunotherapy in epithelioid angiomyolipoma: a report on the successful treatment of a rare malignancy.

J Immunother Cancer 2018 10 1;6(1):97. Epub 2018 Oct 1.

Department of Medicine, NYU Langone Health, New York, NY, USA.

Background: Malignant angiomyolipoma is an uncommon tumor of the class of perivasciular epithelioid cell neoplasms (PEComas). These tumors are characteristically driven by deleterious mutations in the tumor suppressors TSC1 and TSC2, whose gene products typically act to inhibit mTOR. There are several cases of malignant angiomyolipoma which exhibit transient responses to mTOR inhibitors, forming the basis of current practice guidelines in malignant PEComa. However the tumors ultimately acquire resistance, and there is no well-established second-line option. Despite the increasing prevalence of immunotherapy across a wide range of solid tumors, little is known about the immune infiltrate and PD-L1 expression of angiomyolipoma. Furthermore, there is no reported case on the treatment of malignant angiomyolipoma with an immune checkpoint inhibitor.

Case Presentation: A 38 year-old man presented with gross hematuria and was diagnosed with renal epithelioid angiomyolipoma. Despite surgical resection, the tumor recurred and metastasized. Targeted genomic sequencing revealed a deleterious mutation in TSC2, and the patient was treated with the mTOR inihbitor everolimus. The patient went on to have a partial response but ultimately progressed. He was then treated with the anti-PD-1 immune checkpoint inhibitor nivolumab, and achieved a durable near-complete response which is ongoing after two years of treatment. Immunohistochemical staining of tumor tissue revealed strong PD-L1 expression and a brisk T-cell infiltrate.

Conclusions: We report on the first durable systemic treatment of malignant epithelioid angiomyolipoima with the use of PD-1 antibody nivolumab. Given the absence of prospective clinical trials in this exceedingly rare disease, particularly in the second-line setting, immune checkpoint inhibitors like nivolumab should be considered.
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http://dx.doi.org/10.1186/s40425-018-0415-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167873PMC
October 2018

Raynaud's phenomenon: Current concepts.

Clin Dermatol 2018 Jul - Aug;36(4):498-507. Epub 2018 Apr 10.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA. Electronic address:

Raynaud's phenomenon (RP) is a transient, acral, vasospastic phenomenon that manifests with characteristic color changes. This vasospasm, classically triggered by cold temperatures, may also be driven by shifts in temperature, climate, or emotional state. Primary RP (PRP) is a common condition without severe sequelae. Secondary RP (SRP), which may be driven by vascular, autoimmune, hematologic, or endocrine etiologies, can result in digital ulceration, irreversible ischemia and necrosis, and secondary infection. This review delineates the clinical manifestations of both primary and secondary RP, as well as the current understanding of RP epidemiology and pathogenesis. Proper examination, including nailfold capillary microscopy, and laboratory workup for secondary causes of RP are also discussed. The traditional armamentarium of therapies used for RP, as well as newer medical and surgical options, is also summarized with particular regard to the clinical evidence for their efficacy.
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http://dx.doi.org/10.1016/j.clindermatol.2018.04.007DOI Listing
December 2018

Primary anetoderma with undifferentiated connective tissue disease.

Dermatol Online J 2017 Dec 15;23(12). Epub 2017 Dec 15.

New York University Health, New York.

Anetoderma is a rare benign elastolytic disorder that is characterized by focal loss of elastin fibers on histopathology and is often recalcitrant to treatment. We present a case of a patient with a 20-year history of pruritic and painful hyperpigmented atrophic papules clustered on the neck, axillae, inframammary folds, and right medial thigh. Although the histopathologyof her axillary lesions was consistent with anetoderma, her clinical presentation is unusual given the extent of involvement, reported pain and pruritus, and sharp demarcation of the distribution. The diagnosticuncertainty of this case led to added difficulty in management of a disease that is already notoriously difficult to treat and may significantly impact patient's quality of life.
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December 2017

Generalized hyperhidrosis secondary to presumed eccrine gland dysfunction with possible apocrine metaplasia.

Dermatol Online J 2017 Dec 15;23(12). Epub 2017 Dec 15.

New York University Health, New York.

We present a 57 year-old man presented with generalized hyperhidrosis and widespread, smooth, flesh colored papules on the torso and extremities.Histological examination from multiple biopsies demonstrated morphologic alteration of the eccrine glands with an apocrine phenotype, suggesting eitherapocrine metaplasia or the presence of "apoeccrine glands." The morphologic similarities between eccrine, apocrine, and apoeccrine as they relate to ourpatient's histologic findings are discussed. We consider secondary causes of generalized hyperhidrosis, which may also play a role in this patient's presentation. Treatment and further workup are discussed, whilemanagement of this patient remains in progress.
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December 2017

Epidermolysis bullosa acquisita.

Dermatol Online J 2017 Dec 15;23(12). Epub 2017 Dec 15.

New York University, New York.

Epidermolysis bullosa acquisita (EBA) is a rare, acquired subepidermal blistering disease. EBA is characterized by autoantibodies to collagen VII,which serves to link the epidermis to the dermis. The two most common presentations of EBA are classical noninflammatory EBA and bullous pemphigoid-like EBA. Diagnosis of EBA can be challenging as it sharesclinical and histopathologic features with other blistering diseases. Treatment is often recalcitrant and will often necessitate multiple therapies. We presenta case of a thirty-six-year-old Chinese man with EBA and review the literature.
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December 2017

Black eschars on the face and body.

Cutis 2017 Nov;100(5):281;297;298

Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, USA.

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November 2017